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doctor101
22.08.2008, 23:02
Одной из первых причин,о которой нужно подумать в таких случаях,и что ЧАЩЕ всего встречается при перепадах давления,это дисфункция евстахиевой трубы,а не отит.
В любом случае,если симптоматика не проходит самостоятельно,следует обратиться к врачу на осмотр.Он и решит,нужно ли делать какие либо исследования,или достаточно назначения лечения.

ENT_1
22.08.2008, 23:16
Не согласна. Дисфункция слуховой трубы - это причина возможного отита (туботита) во время перепадов давления. Читайте книжки.

Foxa
22.08.2008, 23:32
Простите, может, я чего-то не вижу. С чем именно Вы не согласны? О чем именно нужно читать в книжках?


doctor101
22.08.2008, 23:34
Не согласна. Дисфункция слуховой трубы - это причина возможного отита (туботита) во время перепадов давления. Читайте книжки.
Это вам нужно читать книжки,тогда и не писали бы в звании лор-врач чушь,которую пишете.
Сами же пишете дисфункция слуховой трубы-ПРИЧИНА возможного отита.
Так что первично отит или его причина-дисфункция.:mad:

ENT_1
22.08.2008, 23:37
Одной из первых причин,о которой нужно подумать в таких случаях,и что ЧАЩЕ всего встречается при перепадах давления,это дисфункция евстахиевой трубы,а не отит.

Здесь как раз-таки наоборот - дисфункция слуховой трубы - причина возникновения отита при перелетах, а не наоборот.

dr.Ira
22.08.2008, 23:43
Здесь как раз-таки наоборот - дисфункция слуховой трубы - причина возникновения отита при перелетах, а не наоборот.Коллега! Причина возникновения отитов - вирусы и микробы.:)
Acute otitis media usually arises as a complication of a preceding viral upper respiratory infection (URI). The secretions and inflammation cause a relative occlusion of the eustachian tubes. Normally, the middle ear mucosa absorbs air in the middle ear. If air is not replaced because of relative obstruction of the eustachian tube, a negative pressure is generated and causes a serous effusion. This effusion of the middle ear provides a fertile media for microbial growth, and, with the URI, introduction of upper airway viruses and/or bacteria into the middle ear may occur. If growth is rapid, the patient will have a middle ear infection. If the infection and the resultant inflammatory reaction persist, perforation of the tympanic membrane or extension into the adjacent mastoid air cells may be present. [Ссылки могут видеть только зарегистрированные и активированные пользователи]
Видите ли, "мыши и тараканы не самозарождаются от грязи".:)


ENT_1
22.08.2008, 23:46
А что Вы скажете про экссудативный средний отит? Он тоже вызван микробами?

doctor101 внимательно прочитайте свой первый пост: вы пишите что при перепадах давления возникает дисфункция слуховой трубы.
Это не так. Дисфункция слуховой трубы возникает по другим причинам, предшествующим полету. Вот сочетание дисфункции трубы и перепада давления (здесь причина изначально-дисфункция) приводит к среднему отиту (какому именно не уточняю)

Morphey
22.08.2008, 23:52
Говрить ничего не нужно. Прочтите эту статью ([Ссылки могут видеть только зарегистрированные и активированные пользователи]), доктор, и возможно, наконец, мы заговорим на одном языке...

Foxa
22.08.2008, 23:54
Я поняла так, что доктор Полонский и Вы пишете про одно и то же. Просто доктор Полонский пропустил "причин ушной боли", неправильно построил предложение.


Morphey
22.08.2008, 23:55
Если вдруг в доступе откажут, здесь начало... о чем Вы пытаетесь спорить?

Background

Otitis media with effusion (OME) is characterized by a nonpurulent effusion of the middle ear that may be either mucoid or serous. Symptoms usually involve hearing loss or aural fullness but typically do not involve pain or fever. In children, hearing loss is generally mild and is often detected only with an audiogram. Serous otitis media is a specific type of OME caused by transudate formation as a result of a rapid decrease in middle ear pressure relative to the atmospheric pressure. The fluid in this case is watery and clear.

Understanding the difference between OME and other forms of middle ear infections is important. Otitis media is a generic term defined as an inflammation of the middle ear without reference to a specific etiology or pathogenesis. Because all pneumatized spaces of the temporal bone are contiguous, inflammation of the middle ear may involve inflammation in the other 3 spaces: the mastoid, perilabyrinthine air cells, and the petrous apex. The term otitis media is often used to describe any of a continuum of related diseases: acute otitis media (AOM), recurrent acute otitis media (RAOM), OME, and chronic otitis media with effusion (COME).

AOM is a viral or bacterial infection of the middle ear that causes a rapid onset of signs and symptoms such as pain, fever, irritability, anorexia, and vomiting. Significant inflammation is present on physical examination, both on the tympanic membrane and in the middle ear effusion (MEE) in the form of purulence.


Pathophysiology

OME can occur during the resolution of AOM once the acute inflammation has resolved. Among children who have had an episode of AOM, as many as 45% have persistent effusion after 1 month, but this number decreases to 10% after 3 months.

Two main theories of the cause of AOM exist. The classic explanation proposes that eustachian tube dysfunction is the necessary precursor. The eustachian tube has been traditionally described to provide 3 main functions: equilibration of pressure between the middle and external ears, clearance of secretions, and protection of the middle ear. Its dysfunction can be caused by any number of circumstances from anatomic blockage to inflammation secondary to allergies, upper respiratory tract infection (URTI), or trauma.

If eustachian tube dysfunction is persistent, a negative pressure develops within the middle ear from the absorption and/or diffusion of nitrogen and oxygen into the middle ear mucosal cells. If present for long enough and with appropriate magnitude, the negative pressure elicits a transudate from the mucosa, leading to the eventual accumulation of a serous, essentially sterile effusion. Because the eustachian tube is dysfunctional, the effusion becomes a sessile medium ideal for the proliferation of bacteria and resultant AOM. This classic model is somewhat incorrect, since multiple studies have revealed that the same pathogenic bacteria are present in OME as in AOM.

The newer models describe the primary event as inflammation of the middle ear mucosa caused by a reaction to bacteria already present in the middle ear. Indeed, Bluestone and others have shown (using radiographic evidence) that reflux up the eustachian tube is demonstrable in children prone to otitis media. Furthermore, in 2007, Crapko et al demonstrated the presence of pepsin in the middle ear space of 60% of children with OME.1 This reflux certainly may also occur in otherwise healthy individuals. The inflammatory mediators released as a result of bacterial antigenic challenge induce the up-regulation of mucin genes. The production of a mucin-rich effusion then provides an ample medium for the proliferation of bacteria and resultant AOM.

Yilmaz et al published a study in 2004 that documented significant changes in oxidative stress in patients with OME.2 They demonstrated a significantly improved but not normalized level of oxidants following the placement of ventilation tubes. However, the role of antioxidants in the treatment of OME has yet to be fully investigated.

Regardless of the cause of AOM, eustachian tube dysfunction is nearly universal in OME. As further evidence, ligation of the eustachian tube in animals invariably leads to the formation of a persistent MEE. Once the acute inflammation and bacterial infection have resolved, a failure of the middle ear clearance mechanism allows MEE to persist. Many factors have been implicated in the failure of the clearance mechanism, including ciliary dysfunction; mucosal edema; hyperviscosity of the effusion; and, possibly, an unfavorable pressure gradient.

OME does not necessarily follow AOM. Theories to explain the development of MEE in this case include the secretion of fluid from inflamed middle ear mucosa. This theory proposes that the middle ear mucosa is sensitized by previous exposure to bacteria, and continued antigenic challenge from occasional reflux induces the production of the effusion. Again, multiple studies have revealed that the same flora of bacteria is present in OME as in AOM; these findings indicate that this effusion is not sterile, as was once believed.

OME is ubiquitous in children who have a cleft palate. The cause is simply the lack of proper insertion of the tensor veli palatini muscle in the soft palate. The muscle is, therefore, unable to open the eustachian tube on swallowing or wide mouth opening. A functional obstruction of the tube results.

Morphey
22.08.2008, 23:57
Causes

The same flora found in AOM can be isolated in OME. With OME, the inflammatory process has clearly resolved, and the volume of bacteria has decreased. However, because of the similarity of AOM and OME, reviewing the pathogenic organisms in AOM is worthwhile.

* The most common bacteria in AOM, in order of frequency, are Streptococcus pneumoniae, Haemophilus influenzae, and Moraxella catarrhalis. These pathogens are also the most frequent organisms associated with sinusitis and pneumonia. Together, these pathogens account for 85% of acute ear infections.
*
o S pneumoniae is found in 35% of cases, and the prevalence does not seem to vary with age. The serotypes most commonly isolated, in order of frequency, are 19, 23, 6, 14, and 3.
o H influenzae is found in 20% of cases. Of these cases, 25-45% involve beta-lactamase production, with a clear trend of increasing resistance.
o M catarrhalis is found in 4-13% of cases of AOM, with a great frequency in winter and autumn. Of these cases, 70-100% involve beta-lactamase production.
o Additional bacterial pathogens include Streptococcus pyogenes, Staphylococcus aureus, gram-negative enteric bacteria, and anaerobes. When an effusion is present for longer than 3 months, Pseudomonas species predominate.
o In 30% of examined tympanocentesis specimens, microorganisms are not found. In a meta-analysis of results from 10 studies of tympanocentesis in AOM from the early 1990s, 29 (4.4%) of 663 patients had a virus that could be isolated. In other recent studies, viruses have been isolated in conjunction with bacteria in 15-20% of cases of AOM. Respiratory syncytial virus and influenza virus were the most frequent. The relation between viral and bacterial infection is controversial. Because viruses have been identified as the sole infective agents in only 4-6% of middle ear aspirates obtained from children with AOM, viruses may promote bacterial superinfection by impairing eustachian tube function.
* The only difference with the pathogens in OME compared with AOM is that the frequency of S pneumoniae is not as high, and H influenzae and M catarrhalis are moderately more common.
* Besides the actual pathogens, environmental factors have been shown in numerous epidemiologic studies to be strongly associated with increased prevalence of OME. These factors include bottle feeding, feeding while supine, having a sibling with OM, attending daycare, having allergies to common environmental entities, having a lower socioeconomic status, living in a home in which people smoke, and having a parental history of OME.
* Age is clearly another predisposing factor in the development of OME. In infants, the eustachian tube has a nearly horizontal orientation (relative to the ground) and develops the 45° angle (as in adults) after several years. In addition, the size and shape of the eustachian tube at birth, unlike those in adults, are unfavorable for ventilation of the middle ear. Multiple studies of children in Denmark revealed that by the time children were aged 1 year, tympanograms were either type B (flat) or type C (negative pressure) in 24% of their ears. Improvement occurred in the spring and summer, while worsening was more common in the winter. Type B tympanograms peaked in children aged 2-4 years, and, as expected with the prevalence of OME, decreased in children older than 6 years.
* Disruptions in the normal opening of the eustachian tube orifice in the nasopharynx are also associated with an increased prevalence of OME. These commonly occur in patients who have a cleft palate and in children with Down syndrome and other disorders affecting the palate. In addition, the decreased mucociliary clearance and higher viscosity of mucus in cystic fibrosis have been hypothesized to account for a higher prevalence of OME in patients with these conditions.
* In adults, recognizing unilateral OME is crucial. This entity must be considered a nasopharyngeal mass until definitively proven otherwise.

FRSM
23.08.2008, 00:02
Имеется совершенно определённая категория, называемая "аеро-отит". О чём идёт речь?! Когда мы перестанем говорить ЛОР-глупости?


ENT_1
23.08.2008, 00:11
Otitis media with effusion (OME) is characterized by a nonpurulent effusion of the middle ear that may be either mucoid or serous. Symptoms usually involve hearing loss or aural fullness but typically do not involve pain or fever. In children, hearing loss is generally mild and is often detected only with an audiogram. Serous otitis media is a specific type of OME caused by transudate formation as a result of a rapid decrease in middle ear pressure relative to the atmospheric pressure. The fluid in this case is watery and clear.

If eustachian tube dysfunction is persistent, a negative pressure develops within the middle ear from the absorption and/or diffusion of nitrogen and oxygen into the middle ear mucosal cells. If present for long enough and with appropriate magnitude, the negative pressure elicits a transudate from the mucosa, leading to the eventual accumulation of a serous, essentially sterile effusion.
Я хочу сказать одно, что изначально, если говорить о причине, при экссудативном отите жидкость в среднем ухе стерильна, только впоследствии присоединяются бактерии или вирусы.
Принципиальный вопрос о причине, все остальное я не обсуждала.

dr.Ira
23.08.2008, 00:17
Имеется совершенно определённая категория, называемая "аеро-отит". Вы об этом? [Ссылки могут видеть только зарегистрированные и активированные пользователи]

Morphey
23.08.2008, 00:28
Скорее всего об Этом ([Ссылки могут видеть только зарегистрированные и активированные пользователи]) и вот об Этом ([Ссылки могут видеть только зарегистрированные и активированные пользователи]).


Morphey
23.08.2008, 00:34
А еще это волшебное состояние скрывается под термином "баротит".
1.Barotitis ([Ссылки могут видеть только зарегистрированные и активированные пользователи])
2.Dysbarism ([Ссылки могут видеть только зарегистрированные и активированные пользователи])

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